The neutrophil-to-lymphocyte ratio predicts major perioperative complications in patients undergoing colorectal surgery.

AIM: The objective of the study was to evaluate the association between the neutrophil-to-lymphocyte ratio (NLR) and the occurrence of perioperative complications in patients undergoing colorectal surgery. METHOD: A retrospective cohort study was conducted of patients who underwent resection for suspected or confirmed colorectal cancer from 2004 to 2012. Patient cohorts with a high vs low NLR were defined by receiver operating characteristic curve analysis. Univariate and multivariate logistic regression was used to determine whether patients with elevated NLR were more likely to suffer perioperative complications. RESULTS: In all, 583 patients were included. A preoperative NLR greater than or equal to 2.3 was significantly associated with a major perioperative complication (OR 2.52, 95% CI 1.26-5.01). On multivariate analysis, a high NLR (OR 2.25, 95% CI 1.12-4.52) and Charlson Comorbidity Index ≥ 3 (OR 4.55, 95% CI 2.17-9.56) were significantly related to major morbidity. No relationships were found between an elevated preoperative NLR and complication type, although there was a trend towards the occurrence of anastomotic leakage. CONCLUSION: Preoperative NLR ≥ 2.3 may be a risk factor for major surgical complications following colorectal resection. Further study is needed to validate this threshold and evaluate the clinical implications of these findings.

A molecular survey of cystic echinococcosis in Sudan.

A survey of cystic echinococcosis in livestock was conducted from May 2001 to July 2003 in central, western and southern Sudan. Hydatid cysts were present in 59% (466/779) of camels, 6% (299/4893) of cattle, 11% (1180/10,422) of sheep and 2% (106/5565) of goats, with little variation among different geographical areas. 532 of these cysts were examined by PCR and could be overwhelmingly (98.7%) allocated to Echinococcus canadensis G6/7 (all of 215 cysts from camels, 112 of 114 cysts from cattle, 134 of 138 cysts from sheep, and all of 65 cysts from goats); the genotype G6 was identified by sequencing 13 of these isolates. Only 2 cysts from cattle belonged to Echinococcus ortleppi. The mean number of cysts per infected animal was much higher in camels (5.1) than in the other species (1.0-1.3), and cyst fertility was higher in camels and cattle (74% and 77%) than in goats and sheep (31% and 19%). Fertile cysts from five human patients from hospitals in Khartoum and Juba belonged to E. canadensis (G6). This study confirms the predominance of the 'camel strain' in Sudan and the infectivity of this strain for humans. This is the first genetic characterization of human CE in Sudan.

Protective efficacy of lambdacyhalothrin-impregnated bednets against Phlebotomus orientalis, the vector of visceral leishmaniasis in Sudan.

Field investigations on the sandfly Phlebotomus orientalis (Diptera: Psychodidae), the vector of Leishmania donovani causing visceral leishmaniasis (VL) in Sudan, were undertaken in two villages (Bellow and Elgamel) and Dinder National Park, to determine the protective value of bednets (polyester, 100 denier) impregnated with lambda-cyhalothrin 10 mg a.i./m2 pyrethroid insecticide. After exposure to treated netting for 30 s, P. orientalis females all died within 1 h. When field-tested in Acacia woodland, treated bednets provided complete protection from bites of the vector. Numbers of P. orientalis females landing on human collectors without bednets or using untreated bednets averaged 32.0 +/- 8.3 or 6.9 +/- 2.7 per man-night, respectively, whereas collectors using treated bednets experienced no sandfly bites during the same period (18.00-06.00 hours, 12 nights in June 1995). Socio-behavioural observations on the bed-time of people living in both study villages indicated that the use of impregnated bednets against P. orientalis would give more potential protection for women and children than for male adults. Overall the proportions of people and their durations of exposure to the risk of sandfly bites (i.e. after sunset until they went to bed) were 40% unprotected for< 1h, 50% for 1-2h and >10% for > or = 2h. Because visceral leishmaniasis in Sudan occurs mainly in children, the use of impregnated bednets (outdoors as well as indoors), and going to bed early could provide a high degree of personal protection against this zoonotic infection.

The role of cytokines in Henoch Schonlein purpura.

Serum levels of tumor necrosis factor (TNF) and interleukin(IL-1) were studied in 20 HSP patients, in the acute phase and after remission, by ELISA technique. Skin biopsies obtained during the acute phase both from a lesion and from unaffected skin, as well as during remission, were immunostained for TNF, IL-1, and IL-6. The mean age of the patients was 9.8 (5-13). Mean serum TNF levels during the acute phase and remission were 14.0 +/- 8.9 pg/ml, and 6.8 +/- 2.4 pg/ml, respectively (p < 0.05). Serum TNF levels in patients with renal involvement (18.8 +/- 10.2 pg/ml) were significantly higher than in those without (10.8 +/- 6.5 pg/ml) (p < 0.05). Serum levels of IL-1 in the acute phase and remission were undetectable. All specimens showed leukocytoclastic vasculitis. Immunohistochemical studies revealed TNF, and a less intense IL-1 and IL-6 staining in the nucleated epidermal layer, with a granular, intracellular pattern. Staining was significantly increased in the affected skin during the acute phase. These results suggest that TNF, IL-1, and IL-6 may play a role as a mediator of inflammation in HSP.